The tide is turning on harm reduction. The reins of a new national drug strategy are squarely in the hands of Health Canada. There are positive signs legislators are abandoning ideology for evidence-based policy, and stonewalling for action. Last year, the opioid crisis claimed 916 lives in B.C. alone.

The momentum for supervised injection sites builds on other initiatives, including methadone treatment and a growing network of needle-exchange programs, officially around since 1989.

Harm reduction measures help decrease health risks for drug users at all stages of addiction and recovery. Measurable outcomes include reduced transmission of HIV and hepatitis C through needle sharing, fewer overdose deaths and greater access to addiction recovery supports.

The same positive health outcomes are mirrored in jurisdictions with prison-based needle-exchange programs -- but despite years of advocacy, Canadian inmates don't have access to this health service. Yet it stands to reason they would have an even greater impact in penitentiaries, where the risks associated with IV drug use are much higher.

The statistics are laid out in Clean Switch: The Case for Prison Needle and Syringe Programs in Canada, a 2009 policy paper funded by the Public Health Agency of Canada. It estimated the prevalence of HIV in federal and provincial prisons to be at least 10 times the reported incidence among the broader population.

Hepatitis C prevalence was at least 20 times higher.

The report's authors, Sandra Chu and Richard Elliott of the Canadian HIV/AIDS Legal Network, cite "significant evidence" prison needle and syringe programs reduce the risk of transmission, among other health benefits for prisoners. They also note needle exchanges "do not pose health and safety risks to prisoners or prison staff, and do not increase drug use."

These health outcomes are corroborated by the Office of the Correctional Investigator, which has called for Correctional Service Canada (CSC) to implement more comprehensive harm reduction measures mirroring those available in the community. Currently, inmates can access methadone treatment and bleach to disinfect equipment, which is often improvised and shared.

In 2012, Chu's organization and three other AIDS advocacy organizations launched a constitutional challenge with former federal inmate Steven Simons, who contracted hepatitis C from used injection equipment. The lawsuit does not seek any financial settlement -- its goal is to establish needle-exchange programs in federal institutions. The application is supported by medical organizations including the Canadian Public Health Association.

Resolution seemed on the horizon, with the parties scheduled to begin mediation next week. But the government abruptly withdrew from mediation without explanation. "We were left scratching our heads," Chu said this week.

A spokesperson for Public Safety and Emergency Preparedness commented: "The minister has not yet made a decision on whether to participate in mediation."

Asked for clarification, CSC responded: "CSC is not closed to mediation," citing consultation with government partners on harm reduction measures and other initiatives to reduce infection.

Chu says the challenge will move forward without delay. "We would like to resolve this outside a lawsuit but we need to have a willing partner," she said.

Prisoners' health is public health. More than 90 per cent of inmates are eventually released back to the community. Public Safety affirms: "Prevention and treatment of infectious diseases . . . protects not only the federal offender population, but also correctional personnel and the Canadian public."